What is childhood apraxia of speech?
Childhood apraxia of speech (CAS) is a neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone.) The core impairment in planning results in errors in speech sound production and prosody (ASHA, 2007). Children with CAS have difficulties with motor planning as it relates to speech sound production.
They know what they want to say but have difficulty getting their message out.
Early Signs of Childhood Apraxia of Speech in Toddlers
- Limited vocal play and babbling
- Described as a “quiet baby”
- Difficulty imitating sounds or words
- Difficulty simplifying words to make them easier to say
- Not consistently adding new words to their vocabulary
- May demonstrate social avoidance due to awareness of communication difficulty
- Limited use of varied vowels and consonant sounds
- Inconsistent speech sound errors – a child could say the same word 5x and it would sound different each time the word was produced
- Understanding of language far exceeds the production of language
How Does Childhood Apraxia of Speech Treatment Differ from Traditional Speech Therapy?
Treatment for CAS is rooted in the principles of motor learning. Factors related to motor learning include:
- Attaining and sustaining motivation
- Frequency of practice
- Targets must include: highly frequent, relevant, functional, and motivating words
- Providing specific feedback (e.g. I heard your popping ‘p’ sound that time!) rather than vague feedback (e.g. Great job!) *Your SLP can help you in providing meaningful feedback to your child during practice at home*
(Maas et al 2008)
Childhood Apraxia of Speech Goals
While traditional therapy targets specific speech sounds, our childhood apraxia of speech goals aims to establish new neural pathways or fix the existing ones.
To achieve this goal, the child will require repetitive practice. Practice should target movement patterns in syllables known as co-articulation, rather than individual and specific speech sounds. The movement patterns targeted will increase in complexity as therapy progresses.
Your SLP will assist you in establishing appropriate, functional targets to progress your child’s expressive language skills. Repetition of target words and frequent practice is essential in establishing notable gains in skill.
Involving Caregivers and Family in Child Apraxia of Speech Therapy
Caregivers and family members play an integral role in treatment! There are plenty of ways to make learning fun while still getting lots of practice at home! Children learn best during daily routines and during play. If you suspect your child may have CAS, here are some strategies for home practice.
10 Suggested Activities for Repetitive Practice
- Counting books (instead of counting 1-5, repeat the object name: bee, bee, bee, bee, bee)
- Use lift the flap books to play “knock knock”
- Read repetitive books such as Brown Bear Brown Bear (have the child fill in expectant pauses – I see a red bird looking at ____. Have your child finish the sentence by verbalizing “me”)
- Create a picture book of family members (have your child identify the people in her family and name them as they flip through the book)
- Play peek-a-boo! (pause before “boo” and see if your child will fill it in. This is a great game to elicit many repetitions of the same word while also maintaining their interest and engagement in the activity)
- Bubbles/popper toys (pop, pop, pop!)
- Stacking cups/blocks (practice words such as up, up, up, down, down, down)
- Practice saying “bye bye” to all objects as you clean up an activity
- Velcro playing food (target words: cut, eat – on repeat)
- Ball and hammer toys (target words such as bang! boom! on repeat)
In Honor of Apraxia Awareness Day and Month
Did you know that May 14th is Apraxia Awareness Day and May is Apraxia Awareness Month?
For more information and resources, visit www.apraxia-kids.org.
About the Author
Alyssa Mignone is a pediatric speech language pathologist at NAPA Center Boston. Alyssa loves putting the “fun” in functional by using everyday routines to create meaningful language opportunities for children to grow. When she’s not at work, you can find her skiing, hiking, or relaxing at the beach!
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